I was at my gym last night. Billy Joel’s ballad about trust was the metronome to my squats. Though vaccinated and boosted, I was wearing my mask. I know the latest evidence about vaccines and natural immunity, the dramatic transmissibility but mild virulence of the latest Omicron variant.
So my mask was only for optics. Someone might recognize me as a doctor in the local hospital where masking is still mandated. After all, physicians have long worked for societal trust. Several maskless fellow gym rats gave me quizzical, if not askance, looks, and I felt like a hypocrite. Optics trumps “science.”
I clicked on my cell phone’s news feed between sets. One caught my eye: “Bill Maher goes on Joe Rogan to urge people to ‘not trust medical professionals.” My favorite comedic intellect and influencer turns his acerbic wit on our profession.
Trust is fundamental to the delivery of optimal health care. Based on physicians’ extraordinary training and experience, our continually evolving peer-reviewed science as bedrock, and our orientation to societal service, the profession has been endowed with coveted cultural authority. As sociologist Paul Starr wrote in The Social Transformation of American Medicine, cultural authority raises the likelihood that a particular definition of reality and judgment of meaning and value will prevail as valid and true. We’re losing it.
Our cultural authority is crucial for patients to comply with taking needed medications and our advice for evidence-based intervention. That is why we bemoan the intrusion of insurance companies and lawyers into the patient-physician relationship: It’s counter-therapeutic. Loss of trust in one’s physician reduces compliance with even the simplest advice. “You need to quit smoking and lose a few pounds” coming from an obese physician is viewed with skepticism.
Trust is foundational for public health policy, the purpose of which is the promotion of overall societal health and well-being. However, public health authorities have to put individual risk aside and weigh priorities using the utilitarian principles of the greatest good for the greatest number. Those priorities change with fluid facts on the ground. To maintain trust, transparency regarding priorities while balancing overall societal well-being is crucial. Once trust erodes, it is difficult to rebuild.
When the authorities first stated masks were unnecessary, the science was ambiguous. For Dr. Fauci to later admit that truth was purposefully sacrificed to preserve mask supply, that eroded trust. Even most recently, President Biden chose to send millions of N95 masks to pharmacies in the face of Omicron, implying that surgical masks do not work so well. It’s fair to admit research evolves. That is the underpinning of the scientific method. Science learns, politicians not so much.
The muddled messaging regarding vaccination and how many boosts are needed, what herd immunity means, where masking is and isn’t needed, are examples of sowing distrust. The authorities understandably want everyone vaccinated. Yet those previously infected acquire immunity (as studies cited by the CDC documented early this year). That data would harm the important goal of getting those unvaccinated to get one, so science has been sacrificed at the altar of one size fits all health policy. Accepting that many are smart enough to understand both the need for vaccinating all possible while acknowledging that acquired immunity from infection contributes to population immunity is important when trust is critical.
F. Scott Fitzgerald wrote: ”The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function.” The arrogance of some academicians and politicians dictates that the common mind is not first-rate, and therefore messaging must be one size fits all. But when the seemingly opposite concepts can be simply reconciled, absolutism begs distrust and is thus counter-productive. It makes it hard to explain re-infections after vaccination, or prior infection. Scaring people that contracting COVID is deadly, with mixed messaging makes “simple” minds ask: Do vaccines not work? Why get vaccinated if that does not allow a return to normal?
Immunity does not stop re-infection that can be detected with a positive test, but it mostly stops significant illness. A recent VA study showed that re-infection could lead to hospitalization in a minority, but deaths are rare. The CDC just reported estimates that 58 percent of all Americans (75 percent of all kids) had contracted COVID. That equates to 182 million Americans, most asymptomatic, or with mild symptoms. Yes, we should all get vaccinated for both annually. But the only way to stop re-infection for a respiratory virus that mutates is to stop breathing or wear an N95 mask all the time, and the latter is not 100 percent.
Threats from public health officials aim to have the collective population obey well-intended advice. Yet unbalanced “doom porn” is driving an upsurge in the mental health crisis, delayed care for routine childhood vaccinations, domestic abuse, ambient irritability, and documented accumulating harm to children’s development by irrational school policy (not to mention delays in needed cancer screenings and individuals seeking care for chronic and even urgent health conditions like heart attacks and strokes.
Infection control should not be the sole metric of public health policy whose aim is overall societal health and well-being: Trust is the bedrock of health policy. That crumbling bedrock needs solidification. Bill Maher is right, we physicians have met the enemy, and it includes us. We need to provide individual-specific advice. Even Dr. Fauci conceded that we could only provide valid data and guidance. COVID, especially with the highly transmissible Omicron variant, is becoming endemic, and we will treat it like the seasonal flu. The rest should be left up to one’s personal level of risk tolerance in discussion with trusted physicians.
None of us is getting out of this alive. COVID taught us the importance of superb hospital facilities and truly specialized expert physicians affiliated with them. Trusting credible physician advice for a given individual’s situation and not simply relying on talking heads feeding us laced Kool-Aid betters one’s health.
Michael Brant-Zawadzki is a physician executive.
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